ESI Dilemma: Should Employees with Higher Salaries Get ESIC Medical Benefits?

Dear HR Veterans,

In view of the amendment in ESI with respect to the wage ceiling limit up to 15,000/- rupees, in our company, some of our employees have gross salaries higher than 15,000/- rupees. Both employee and employer contributions are made, but no medical facilities are extended to employees in our company hospital. In this case, I seek clarification on whether they should be covered under ESIC or not, or receive medical facilities in an ESIC hospital.

Regards,
Gaurav

ESI Benefit Eligibility and Contribution

ESI benefit is only applicable to employees whose gross salary is less than or equal to 15,000. However, if any employee's salary gets increased during the contribution period (April to September or October to March), then the contribution for that employee should be made until the end of that contribution period. For example, if you increased an employee's gross salary and made it more than 15,000 on 10th November '15, then you have to deposit both contributions until 31st March '16. After that period, you should take them out of the scheme.

Employees can opt for ESI benefits from the corresponding benefits period, i.e., after 3 months of the closure of any contribution period.

Medical Benefits Under ESI

The medical benefit can only be taken from any of the ESI dispensaries or ESI-affiliated hospitals. For any kind of treatment, the insured employee or their dependent should visit the ESI dispensary first. In case the ESI dispensary or affiliated hospitals fail to provide full treatment, they will refer your case to other hospitals, and in that case, they will also reimburse the expenses to the maximum extent as per ESI policy.

I hope this information will be helpful for you.

Regards